Question:Do I need to give my breastfed infant vitamin/mineral supplements?
Answer: Human milk with its unique and dynamic composition is nutritionally complete, and there is no need to give an infant a broad-spectrum vitamin/mineral supplement. However, there are some specific nutrients that should be given close attention.

Vitamin K is given one time at birth, as there are only small amounts found in breastmilk, and it takes time for the intestinal flora in the gut to start producing adequate amounts of vitamin K. The reemergence of vitamin D deficiency (Rickets) among breastfed infants in the United States has generated discussion and debate about universal vitamin D supplementation for breastfed infants. Human milk does not contain large amounts of vitamin D, but all breastfed infants are not at risk for vitamin D deficiency, as the need for the vitamin can also be met through exposure to the sun. However, dark skin acts as a sunscreen and decreases the amount of vitamin D produced; thus, infants who are not exposed to the sun, who are dark-skinned, or who are covered with sunscreen are at the greatest risk. Therefore, vitamin D supplementation may be prudent for infants living in the northern part of the country, especially if they are dark-skinned. Adequate sun exposure for a light-skinned infant is two hours per week clothed. If it is determined that vitamin D supplementation is needed, a safe and adequate amount is 200 IU/day.

Iron and fluoride are two more often-debated supplemental nutrients. Minerals in human milk are largely protein bound and balanced, which enhances bioavailability. Independent of the mother's iron status, a term infant is born with adequate iron stores and utilizes little dietary iron before the age of 4-6 months. And, as stated previously, the iron in breastmilk is readily absorbed. There is no need to supplement a term infant's diet with iron before

the age of six months, however, a premature infant may need iron supplements at two months of age because they lack the iron stores. After six months of age iron should come from dietary sources such as iron-fortified infant cereal, meats, dried beans and green leafy vegetables.

Fluoride levels in human milk are not abundant. It is found in varying concentrations in all drinking water as well as in soil. The American Academy of Pediatrics and the American Academy of Dentistry recommend that all children older than six months of age, breastfed or formula fed, be given fluoride supplements if they live in an area where the fluoride level of the water is less than 0.3 ppm. Optimal fluoride concentration in water for teeth is .7-1.2 ppm. Use of fluoride supplements is indicated for children in non-fluoridated areas, such as San Diego County. Since fluoride levels in water naturally vary, it is best to contact your local water district to obtain information on current levels. As a supplement, a daily dose of 0.25 mg. of fluoride is recommended between the ages of six months and three years. The quantity increases with age. It is important not to give excess fluoride as it can cause damage to teeth in the early stages of development. For more information on fluoride dosage see the American Academy of Pediatrics, Committee On Nutrition, Pediatrics 95: 777,1995.

Kelly Barger, R.D., C.L.E., C.D.E.

Kelly has worked for WIC, Naval Medical Center's Midwifery Program and most recently Palomar/Pomerado Health System as their outpatient dietitian.

LLL Conference-Costa Mesa Hilton, Costa Mesa, CA, May 25-26, 2002.

"Breastfeeding: A Gift of Love." The 2002 Southern California/Nevada Area Conference is designed to enable participants to gain a broader perspective of the health ramifications of breastfeeding, to identify factors which influence the breastfeeding experience, and to develop strategies to assist mothers in overcoming difficulties. Activities include: continuing education sessions; Friday night, Saturday and Sunday keynotes; children's activities; ad hoc sessions on Saturday afternoon; Saturday night dinner, entertainment and family dancing; lots of exhibits; great bookstore; drawings for exhibitor donations; and drawing for theme baskets. For more information, email Tina Pulice, Assistant Area Conference Supervisor, at TMPulice@aol.com, or visit http://www.attachusa.com/lll/.

La Leche League International 30th Annual Seminar for Physicians on Breastfeeding--Hilton Sedona, Sedona,Arizona, July 18-20, 2002.

"Breastfeeding: Where Art and Science Meet." This conference will be co-sponsored by LLLI, AAP, ACOG. For more information visit: www.lalecheleague.org/ed/physsem02.html.

Academy of Breastfeeding Medicine 7th International Meeting--Vancouver, BC, Canada, November 14-18, 2002.

"International Breastfeeding: From Evidence to Action." Basic Breastfeeding Course for Physicians. Main meeting with plenary sessions, research abstracts, posters and platform presentations (Physicians only). Follow-up meeting for other healthcare/lactation professionals. More information TBA.

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